BABCP Response - NICE Consultation January 2022

A Psychological Wellbeing Practitioner’s Damning Indictment of Her Role

Last week a PWP (Psychological Wellbeing Practitioner) ALIEE November 25th 2020 put a post on this blog, calling for Panorama to take note of the desperate plight of PWPs – the main providers of services in the Improving Access to Psychological Therapies (IAPT) Service. Unfortunately the track record of the media in this regard is not good. It is a year since Radio 4 chose to broadcast predominantly the voices of  lead figures in IAPT and well known fellow travellers, rather than give expression to those at the coalface  and their clients.   One wonders what it takes for the media to wake up and ‘smell the coffee’ – £4billion has been spent on IAPT over the last decade all without any independent audit. Given the current, parlous state of Government finances this should at least come under independent critical review, perhaps by the Office for Budget Responsibility.

When a PWP candidly admits “I am trained to overlook the full picture”, it raises eyebrows. Then when ALIEE goes on to say that she operates purely with the ‘5 area model’,  this is jaw dropping.  This is not a model for any psychological disorder, by itself it is a heuristic for providing generic cbt, which has never been considered an evidence-supported treatment. Then this PWP states if clients still have high PHQ9 and GAD7 scores by the 4th session, it is the client who should be interrogated for their  competence in scoring, with the threat that if such scores persist there is the spectre of criticism from superiors. This is tantamount to fiddling results. It is atrocious that AIEE has been placed in this invidious position. I do not believe she is weak but rather like a prisoner at Auschwitz charged with the removal of dead bodies from a gas chamber.

The burden of proof is with IAPT to demonstrate that it has procedures in place to make it impossible for ALIEE to have been operating in this way. Protestations that ‘there a few bad apples’ in every workforce simply won’t wash.

Getting the media and politicians to listen is like getting the post war German Government to take action against war criminals. Action was only finally taken following many years of work by children of Holocaust victims. Unfortunately in the short term the implicit plea is that ‘we have enough to do with the Pandemic and Brexit, not to say Climate Change’ but the climate of the upcoming generation is affected by the mental health of today’s adults. 

Dr Mike Scott

25 replies on “A Psychological Wellbeing Practitioner’s Damning Indictment of Her Role”

Forget the media and the politicians this issue is between the providers and the commissioners. The providers put a bid they can’t possibly honour in relation with access rate and recovery rate and on this basis are offered the contract. The well being of the PWPs and the therapists does not enter into the equation. It does not make any difference that cases appropriate for specialised ,complex services now land on our caseload. It does not make any difference that they can’t possibly be expected to be recovered in few sessions, the system is rigged and you can’t change the system.

I fear you could well be right Robin, certainly I’ve been spectacularly unsuccessful over the last few years in bringing about any change. But I think you have just got to protest when something is wrong, even if you can’t see a change anytime soon.I have a belief that the horrors don’t have the last word, but I can’t prove it. Operating in hope does at least keep u alert to seeing the possibility that something might at least be a cog in a wheel that makes a difference – was pleasantly surprised recently when British Journal of Clinical Psychology accepted my critique of IAPT. Take good care Robin.

It’s so wrong, this is a system which burns out and destroys the mental health of it’s workforce. The PWPs I have worked with have been some of the brightest, most creative and resourceful people I’ve ever worked with, they deserve better. We all do.

Hi Steve I have today contacted the NAO and asked them to resume their investigation into IAPT, on the basis that £4billion has been spent on it without independent audit. They have promised to reply in 20 days. I have suggested that they take a look at this website to see the numerous complaints from IAPT staff. It is breathtaking Dan that people are being encouraged to score what would be appropriate if they didn’t have their current problem, it is total Alice in Wonderland, the Mad Hatter is going to pop up any minute, it has become a ‘Pantomine’.

A PWP colleague of mine was very recently advised by a clinical lead to ask the client with high PHQ9/GAD7 scores “If your x problem didn’t exist, what would you score yourself?”. This was as a way to improve recovery scores. None of what ALIEE reports is remotely surprising to me. IAPT is so inward looking that it’s starting to resemble some aspects of a cult where propping up the service is the end game sadly – it’s both poor for the client and deskilling for the PWP. I feel the only way to progress is to normalise this bad practice and that’s a dangerous place to be if you ask me.

What is interesting is the disconnect. PWPS and therapists are really kind, warm non judgmental individuals aiming at offering the perfect therapeutic relationship and addressing clients problems as they come with the best of their knowledge and experience.However the reality of the actual transaction as set up by the system starts kicking in at session four when recovery rate becomes the all consuming priority. Supervision can if not handled very well become spaces when clinicians are cross examined. A space where they have to bare their heart and soul so that the supervisor can hopefully pin down the blame, the failure to ..if you are unlucky …yourself. Your tone of voice , not following religiously the disorder specific model, not bending enough backwards and forwards to the wishes of the clients who sometimes …are not ready for treatment or are too complex. Anything as long as there is an explanation.The service is happy , the commissioners are happy (or not) and the therapists are left undermined, traumatised, stressed, going off sick, looking for other jobs. And the charade goes on and on and on…

I’ve definitely felt cross examined in previous services, I’m fortunate that my current supervisor is good. But yeah, I’ve heard of people being threatened with the sack if targets weren’t being consistently met. Absolutely toxic.

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